SURGERY OF THE COLON

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SURGERY OF THE COLON

  1. 1. Surgery of the colon
  2. 2. anatomy <ul><li>Cecum and appendix </li></ul><ul><li>Ascending colon </li></ul><ul><li>Transverse colon </li></ul><ul><li>Descending colon </li></ul><ul><li>Sigmoid colon </li></ul>
  3. 3. features <ul><li>Liquid contents of the ileum to semisolid feaces </li></ul><ul><li>Large caliber </li></ul><ul><li>Appendices epiploica </li></ul><ul><li>Teania coli </li></ul><ul><li>Haustrations-sacculations </li></ul>
  4. 4. Right hemicolectomy <ul><li>Indications </li></ul><ul><li>neoplasms of cecum </li></ul><ul><li>appendix adenocarcinoma </li></ul><ul><li>carcinoids > 2cm size </li></ul><ul><li>nodal metastasis </li></ul><ul><li>ascending colon </li></ul><ul><li>Diverticular desease of Rt side </li></ul><ul><li>Angiodysplastic liesions </li></ul>
  5. 5. Pre operative assessment <ul><li>Complete blood count </li></ul><ul><li>LFT </li></ul><ul><li>Chest x ray </li></ul><ul><li>CEA </li></ul><ul><li>Synchronous lesions 2-8% </li></ul><ul><li>colonoscopy,double contrast Ba enema </li></ul><ul><li>CT scan optional </li></ul>
  6. 6. preparation <ul><li>Liquid diet for 2 days </li></ul><ul><li>PEG </li></ul><ul><li>Antibiotics from day before </li></ul><ul><li>Hydration </li></ul><ul><li>DVT prophylaxis-heparin,pneumatic compression boots </li></ul>
  7. 7. Incision <ul><li>Midline </li></ul><ul><li>Transverse </li></ul><ul><li>paramedian </li></ul>
  8. 8. Mobilisation of the RT colon <ul><li>Assess the operability </li></ul><ul><li>pack the small bowel to the left </li></ul><ul><li>Retract the Rt colon to the midline </li></ul><ul><li>Incise parietal peritoneum-line of toldt </li></ul><ul><li>Mobilise the Rt colon to midline </li></ul>
  9. 9. <ul><li>Plane of dissection b/n retro peritoneal fat and mesentry </li></ul><ul><li>Ureter, gonadal vessel, IVC, duodenum </li></ul><ul><li>Mobilise the hepatic flexure, transverse colon </li></ul>
  10. 10. Bowel resection <ul><li>Select the deviding point -ileum, tr.colon </li></ul><ul><li>Ileocolic, Rt colic, Rt branch of middle colic </li></ul><ul><li>Tr. Colon devided just to the Rt of main trunk of middle colic </li></ul><ul><li>10 cms of terminal ileum </li></ul><ul><li>For hepatic flexure growth extended RHC, Lt branch of the middle colic also sacrificed </li></ul>
  11. 11. Anasthamosis <ul><li>Hand sewn double layer </li></ul><ul><li>single layer </li></ul><ul><li>stapler </li></ul>
  12. 12. <ul><li>End to end </li></ul><ul><li>End to side </li></ul><ul><li>Side to side </li></ul>
  13. 13. Extended left hemicolectomy <ul><li>Inf mesenteric artery ligated at the root </li></ul><ul><li>The distal transverse,splenic flexure,descending ,sigmoid and upper rectum are removed </li></ul><ul><li>Regional mesentericand pericolic LN are removed </li></ul>
  14. 14. <ul><li>In Lt HC Lt colic alone is ligated </li></ul><ul><li>For splenic flexure growth along with Lt colic Lt branch of middle colic also devided </li></ul>
  15. 15. <ul><li>Small bowel and sigmoid retracted cephalad and to the right </li></ul><ul><li>Descending colon retracted to the midline </li></ul><ul><li>Lateral peritoneum incised </li></ul><ul><li>Gonadal vessel, ureter are visualised </li></ul><ul><li>Mobilise the splenic flexure </li></ul><ul><li>Splenocolic ligament </li></ul>
  16. 16. <ul><li>Anasthamosis can be end to end, end to side, </li></ul><ul><li>or side to side </li></ul><ul><li>No tension at the site </li></ul><ul><li>Hand sewn </li></ul><ul><li>Stapler </li></ul>

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